REVIEW  FDG PET/CT FOR INFECTION AND INFLAMMATION: A PRACTICAL APPROACH 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2025 March;69(1):4-16

DOI: 10.23736/S1824-4785.25.03618-0

Copyright © 2025 EDIZIONI MINERVA MEDICA

language: English

Role of FDG PET/CT in bacteremia and fever of unknown origin: a pictorial overview of finding the culprit

Ayah A. NAWWAR ^{1, 2, 3} ✉, Soren HESS ^{4, 5}, Lucia LECCISOTTI ^{6, 7}, Francois JAMAR ⁸, Edel NORIEGA-ALVAREZ ⁹, Domenico ALBANO ¹⁰, Olivier GHEYSENS ⁸

¹ Cobalt Medical Charity, Cheltenham, UK; ² University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, UK; ³ Clinical Oncology and Nuclear Medicine Department, Cairo University, Cairo, Egypt; ⁴ Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; ⁵ Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; ⁶ Section of Nuclear Medicine, Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy; ⁷ Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; ⁸ Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium; ⁹ Department of Nuclear Medicine, University Hospital of Guadalajara, Guadalajara, Spain; ¹⁰ Nuclear Medicine Department, University of Brescia, ASST Spedali Civili, Brescia, Italy

¹⁸F fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography/computed tomography (PET/CT) has established itself as a critical diagnostic tool in the evaluation of patients with bacteremia and fever of unknown origin (FUO), particularly following futile conventional investigations. These conditions are often challenging due to diverse underlying etiologies, including infections, inflammatory conditions and malignancies. PET/CT has the advantage of being a whole-body imaging technique with high sensitivity for detecting areas of increased metabolism often associated with infection or inflammation. In bacteremia, [¹⁸F]FDG PET/CT can help identify metastatic infections, endocarditis, or abscesses which may be clinically silent and missed on conventional imaging. In FUO, it helps to identify underlying etiologies, directing treatment and management strategies. This review aims to describe the role of PET/CT imaging in these diverse clinical scenarios. Perspectives in the field, including novel equipment and tracers, will be briefly discussed.

KEY WORDS: Fluorodeoxyglucose F18; Positron emission tomography computed tomography; Fever of unknown origin; Bacteremia; Infections; Inflammations